Issue #3: The Latest in Critical Care, 6/5/23
Corticosteroids for community-acquired pneumonia have been studied with inconclusive results, and expert guidelines currently advise against their use except in patients with refractory septic shock. Only a few trials have tested the utility of steroids for pneumonia in ICU patients; one of the largest and most recent ones enrolling 586 patients at U.S. veterans’ hospitals did not show a mortality reduction from low-dose methylprednisolone.
In a new randomized trial enrolling about 800 patients admitted to 31 French ICUs with severe community-acquired pneumonia (requiring mechanical ventilation or high-flow oxygen, or with PSI scores >130), those receiving hydrocortisone 200 mg IV daily had a dramatic ~50% reduction in mortality at 28 days, compared to those receiving placebo (~6% vs ~12%). Hydrocortisone was administered by continuous infusion for four days, then continued or tapered for up to 14 days according to pre-specified protocols — atypical regimens by U.S. standards of care. …
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